Ebola was just the beginning. An epidemic is coming and the world is not ready

Red Cross aid workers in Liberia. The team is carrying a body bag to help remove the dead

PASCAL GUYOT / Getty

Are we ready for the 'Big One'; the next virus epidemic that is going to hit the world? Director of London School of Hygiene and Tropical Medicine (LSHTM), microbiologist and expert on infectious diseases, Peter Piot, worryingly, says no and he's not the only one.

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A recent report in the British Medical Journal has shown the world is "grossly underprepared" for another infectious disease outbreak. Scientists from the Graduate Institute of International and Development Studies analysed the global response to Ebola and found that governments and humanitarian organisations failed to tackle key issues such as inadequate investment in state-based health infrastructures, as well as failing to install a reliable global system for prevention, detection and response to disease outbreaks.

"We will not be ready for the next outbreak without deeper and more comprehensive change," the report concluded.

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For Piot, who played a significant role in the effort to contain the first recorded epidemic of Ebola in what is now the Democratic Republic of Congo (DRC) in 1976, this is something he is aware of all too well.

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Speaking at WIRED2016, Piot told the audience about what it was like working on the Ebola crisis in the 1970s and how he was working in a lab in Antwerp when two glass vials swimming in ice arrived in a shiny blue thermos flask.

"It had a note saying, 'Is this Yellow Fever?' and was related to the death of a nun who had died in a missionary in the Congo with what looked like the disease," said Piot.

But on close examination, after the lab team isolated the virus, they realised it was very different to Yellow Fever. It had a spaghetti like structure, unlike other viruses, and this is when Piot and his team received the news from the World Health Organisation (WHO) to stop the investigation.

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"It had become a deadly epidemic in the DNC, up to 90 per cent mortality and we were not equipped in the lab to deal with it, it wasn't a military lab," explained Piot.

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After sending the virus off to a military lab in America, it was confirmed that this was a new virus, named Ebola, after the name of a river near the epidemic's centre.

Peter Piot, Director of the London School of Hygiene and Tropical Medicine

Michael Newington Gray

Piot went to the Congo to work with a team trying to find out how this new virus was transmitted and, more importantly, how it was spreading. By realising it was transmitted when people came into contact with someone who was very ill while in the final stages of the disease, the team tried to prevent the disease spreading any further.

This effort worked, for a time. Ebola continued to pop up every now and again as infrequent outbreaks in central Africa, killing 20 people or maybe 100 at the time.

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"But we were all taken by surprise in 2014, when the epidemic was found in West Africa," said Piot. The disease had never been here before and was spreading over three countries, affecting people in the cities.

"I looked at the Médecins Sans Frontières (MSF) facts, they said it was out of control. I knew this was completely different and we needed extreme measures".

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Sierra Leone was coming out of decades of civil war; in Guinea, where the disease started this time, the corrupt dictatorship meant there was a total lack of trust in the government, and professionals had left the country. And Ebola was in the slum areas, spreading fast.

"You can't put capital cities into quarantine; that wouldn't work in somewhere like London."

After witnessing the latest outbreak of Ebola in West Africa in 2015, Piot was highly critically on the WHO's handling of the disease. He said the organisation took too long to act, allowing the virus to spread fast. And this lack of response needs to inform the way we work in the future. Piot believes we will see many more disruptive epidemics, because of our interconnected, mobile world.

"In Korea, a business man came from the Gulf and carried MERS (Middle Eastern respiratory syndrome) to a hospital in Seoul, causing the death of 30 people," said Piot. "This happened in Toronto, when SARS (severe acute respiratory syndrome) was carried from Hong Kong".

Climate change will also affect the way diseases will spread in the future.

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The race to contain West Africa's Ebola outbreak

"Now mosquitos can survive in places that before were too cold. This means we will see more and more epidemics - and we need to be prepared," Piot told the audience. Although, Piot joked we won't get Zika in the UK as it is too cold for the mosquitos that carry the virus to survive.

Piot also believes there will be a "Big One", a big influenza, similar to the likes of the Spanish Flu in World War One and we're not quite ready for it. Yet.

"Are we ready?' Piot asked. "A little bit better than a few years ago but we're not yet up to the job. We can't afford to wait but we have a plan, and that's the good news."

The world has learnt from the problems of mobilisation around Ebola and we are now in a better situation; there is better technology to allow for more rapid diagnosis.

The UK, for example, recently announced its rapid support team established in collaboration with the LSHTM and Public Health England - a team that can be deployed in 48 hours to deal with crises all over the world. "We have no time to lose," said Piot.

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Piot called for investment in infrastructure and systems, such as labs in the countries most vulnerable; stronger global governance to coordinate international responses; and R&D fit for purpose, to incentivise pharmaceuticals and foundations to create vaccines.